Healthcare Provider Details

I. General information

NPI: 1407067010
Provider Name (Legal Business Name): SWAPNA CHALASANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E BASELINE RD
TEMPE AZ
85283-1511
US

IV. Provider business mailing address

25500 N. NORTERRA PARKWAY, BLDG B
PHOENIX AZ
85085
US

V. Phone/Fax

Practice location:
  • Phone: 480-345-5000
  • Fax: 480-345-5062
Mailing address:
  • Phone: 623-277-1000
  • Fax: 602-906-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.117364
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47901
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: